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A - NAPLEX > Chapter 58: Pain > Flashcards

Chapter 58: Pain Flashcards

1
Q

____ pain occurs when sensory nerves identify tissue namage

A

Nociceptive

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2
Q

Which drug classes can be given for mild pain (score 1-3)

A

Non-opioid +/- adjuvant

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3
Q

Which drug classes can be given for moderate pain (score 4-6)

A

Opioid for mild-moderate pain
+/- non-opioid
+/- adjuvant

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4
Q

Which drug classes can be given for severe pain (score 7-10)

A

Opioid for moderate-severe pain
+/- non-opioid
+/- adjuvant

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5
Q

Acetaminophen does not provide ____ effect

A

anti-inflammatory

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6
Q

Mechanism of APAP

A

inhibits PG synthesis in the CNS

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7
Q

APAP brand names

A

Tylenol, FeverAll, Ofirmev

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8
Q

FeverAll drug formulation

A

rectal suppository

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9
Q

Ofirmev drug formulation

A

Injection

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10
Q

APAP + hydrocodone brand names

A

Lorcet, Lortab, Norco, Vicodin

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11
Q

APAP + oxycodone brand names

A

Endocet, Percocet

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12
Q

APAP + codeine brand names

A

Tylenol #2, #3, #4

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13
Q

APAP + caffeine brand name

A

Excedrin Tension Headache

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14
Q

APAP + ASA + Caffeine brand names

A

Excedrin Extra Strength, Excedrin Migraine

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15
Q

APAP + caffeine + pyrilamine brand name

A

Midol

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16
Q

Max APAP per day for adults

A

< 4000 mg/day

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17
Q

APAP dosing for children < 12 yrs

A

10-15 mg/kg Q4-6H

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18
Q

APAP infants and childrens suspension concentration

A

160 mg/5 ml

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19
Q

APAP BW

A

Severe hepatotoxicity with doses > 4 g/day or use of multiple APAP-containing products

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20
Q

Antidote for APAP overdose

A

NAC, Acetadote

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21
Q

How is NAC administered for APAP overdose

A

IV or PO (using the solution for inhalation or injectable formulation)

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22
Q

How does NAC help with APAP overdose

A

restores hepatic glutathione

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23
Q

Non-selective NSAIDs block the synthesis of

A

both COX enzymes

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24
Q

COX-2 selective NSAIDs block the synthesis of

A

COX-2 only, which decreases GI risk (b/c COX-1 protects the gastric mucosa)

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25
Q

Aspirin MOA

A

irreversible COX-1 & 2 inhibitor

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26
Q

All Rx, non-aspirin NSAIDs require a MedGuide with the following info

A
  • GI risk including bleeding and ulceration
  • CV risk (MI and stroke)
  • CABG surgery: NSAID use is CI after surgery. Antiplatelet therapy is recommended (commonly ASA)
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27
Q

NSAID warnings

A
  • Caution in renal failure
  • Can increase BP
  • Can cause premature closure of the ductus arteriosus (do not use in 3rd trimester)
  • Nausea (take with food)
  • Photosensitivity
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28
Q

If the ductus arteriosus does not close after birth, which NSAIDs can be used

A

IV NSAIDs (indomethacin, ibuprofen) can be used within 14 days of birth

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29
Q

Ibuprofen brand name

A

Advil, Caldolor, Motrin

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30
Q

Which NSAIDs are COX-1 & COX-2 non-selective

A

Ibuprofen, indomethacin, Naproxen, Ketorolac

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31
Q

Adult OTC dosing for Ibuprofen

A

200-400 mg Q4-6H

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32
Q

Pediatric dosing for Ibuprofen

A

5-10 mg/kg/dose Q6-8H

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33
Q

OTC self-treatment with ibuprofen should be limited to

A

< 10 days

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34
Q

Indomethacin brand name

A

Indocin

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35
Q

Indomethacin has a high risk for which side effects

A

CNS (avoid in psych conditions)

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36
Q

Naproxen brand name

A

Aleve

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37
Q

Naproxen + esomeprazole brand name

A

Vimovo

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38
Q

Ketorolac brand name

A

Toradol

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39
Q

How often is naproxen dosed

A

BID

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40
Q

How is Ketorolac nasal spray administered in patients < 65 years

A

1 spray in each nostril

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41
Q

How is Ketorolac nasal spray administered in patients 65+ years

A

1 spray in one nostril

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42
Q

Max combined duration IV/IM and PO/nasal for ketorolac is __ days in adults

A

5

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43
Q

Ketorolac warnings

A

acute renal failure, liver failure

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44
Q

How should ketorolac nasal spray be used

A

Prime 5x before use

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45
Q

Which NSAIDs have increased COX-2 selectivity

A

Celecoxib, diclofenac, meloxicam, nabumetone

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46
Q

Benefit of COX-2 selective NSAIDs

A

lower risk for GI complications (but increased risk of MI/stroke)

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47
Q

Diclofenac brand name

A

Voltaren

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48
Q

Voltaren gel total body max dose

A

32 g/day

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49
Q

Flector patch (diclofenac) is used how many times per day

A

BID

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50
Q

Celecoxib CI

A

sulfonamide allergy

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51
Q

Which COX-2 selective NSAID has the most COX-2 selectivity

A

celecoxib

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52
Q

Diclofenac + misoprostol (Arthrotec) boxed warning

A

Avoid in women of childbearing potential

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53
Q

Why is misoprostol used with diclofenac

A

Used to replace the gut-protective PG to decrease GI risk

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54
Q

Meloxicam brand name

A

Mobic

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55
Q

ASA + omeprazole brand name

A

Yosprala

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56
Q

ASA dose for cardioprotection

A

81-162 mg once daily

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57
Q

ASA side effects

A

Dyspepsia, heartburn, bleeding

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58
Q

What may be used to protect the gut with chronic NSAID use

A

PPIs

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59
Q

Salicylate overdose can cause

A

tinnitus

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60
Q

What ingredient is found in Bengay, Icy Hot and Salonpas

A

Methyl salicylate

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61
Q

How should ASA and ibuprofen be used if taken together

A

Take ASA one hour before or 8 hours after ibuprofen

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62
Q

NSAIDs can increase the levels of which drug

A

Lithium

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63
Q

Opioid MOA

A

Mu receptor agonists

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64
Q

Which opioids cannot be taken with alcohol

A

Kadian, Nucynta ER, Oxymorphone ER & Zohydro

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65
Q

What drug class (DEA) is codeine solution combination products (e.g, cough syrups)

A

C-V

66
Q

Respiratory depression and death have occurred in children following tonsillectomy and/or adeoidectomy found to have evidence of being ultra-rapid metabolizers of codeine due to what polymorphism

A

2D6

67
Q

Codeine should be avoided in children < __ years for any indication & < __ years following tonsillectomy/adenoidectomy surgery

A

12

18

68
Q

Brand name of fentanyl oral transmucosal lozenge (“lollipop on a stick”)

A

Actiq

69
Q

How often is fentanyl patch applied

A

Q72H

70
Q

Fentanyl should be avoided with CYP450 ____

A

3A4 inhibitors

71
Q

A patient who has been using morphine ___ mg/day or equivalent for at least ___ days can be converted to fentanyl patch

A

60

7

72
Q

Similar drug (IV) to fentanyl

A

remifentanil

73
Q

Fentanyl patch can be covered with

A

Only the permitted adhesive film dressings: Bioclusive or Tegaderm

74
Q

How should fentanyl patch be disposed

A

In toilet

75
Q

Hydrocodone should be avoided with CYP450 ____

A

3A4 inhibitors

76
Q

Hydromorphone oral dose

A

2-4 mg Q4-6H PRN

77
Q

Hydromorphone IV dose

A

0.2-1 mg Q2-3H PRN

78
Q

Hydromorphone should only be used in:

A

Opioid-tolerant patients only

79
Q

Hydromorphone has a high risk for

A

overdose

80
Q

Methadone brand name

A

Dolophine

81
Q

Methadone BW

A

QT prolongation (life-threatening)

82
Q

Which C2 opioid has a variable half-life and is hard to dose safely

A

Methadone

83
Q

Which C2 opioid can decrease testosterone levels and lead to sexual dysfunction

A

Methadone

84
Q

Methadone is a major ____ substrate

A

3A4

85
Q

Meperidine brand name

A

Demerol

86
Q

Meperidine warning

A

Renal impairment/elderly at risk for CNS toxicity

87
Q

Which C2 opioid is no longer recommended as an analgesic

A

Meperidine

88
Q

Which C2 opioid has a short duration of action

A

Meperidine

89
Q

What is the metabolite of Meperidine and how is it cleared

A

Normeperidine

Renally (can accumulate and cause seizures)

90
Q

Meperidine, when combined with other drugs, can be

A

serotonergic

91
Q

Morphine ER brand name

A

MS Contin, Kadian

92
Q

Morphine injection brand name

A

Duramorph, Infumorph

93
Q

Morphine SE

A

pruritis

94
Q

What can be given to block histamine-induced pruritis with morphine

A

Diphenhydramine

95
Q

Oxycodone IR brand name

A

Roxicodone

96
Q

Oxycodone CR brand name

A

OxyContin

97
Q

Oxycodone initiation with CYP450 ____ can cause fatal overdose

A

3A4

98
Q

Oxycodone side effect

A

Pruritis

99
Q

How should oxymorphone be taken

A

On empty stomach

100
Q

Which opioids are 3A4 substrates

A

Hydrocodone, fentanyl, methadone, and oxycodone

101
Q

How should opioid conversions be rounded

A

Round down to reduce risk of OD

102
Q

If an exam question says to reduce the dose of an equivalent opioid, how much do you reduce it by

A

25%

103
Q

Morphine & hydromorphone conversions (IV and PO)

A

Morphine: IV/IM 10 mg = PO 30 mg
Hydromorphone: IV/IM 1.5 mg = PO 7.5 mg

104
Q

If using opioids, which formulation should be started first

A

IR

105
Q

What should be done in a true opioid allergy

A

Use an agent in a different chemical class

106
Q

The common drugs in the same chemical class that cross-react with each other have which words in their names

A

cod or morph (or norph)

107
Q

What is the first line laxative for OIC

A

Stimulant laxatives (like Senna)

108
Q

If laxatives are not sufficient for OIC, what can be used

A

PAMORAs

109
Q

If PAMORAs are not effective for OIC, what can be used

A

Lubiprostone

110
Q

PAMORA MOA

A

block opioid receptors in the gut to reduce constipation without affecting analgesia

111
Q

Which meds are PAMORAs

A

Methylnaltrexone, Naloxegol

112
Q

Methylnaltrexone brand name

A

Relistor

113
Q

Naloxegol brand name

A

Movantik

114
Q

Methylnaltrexone & Naloxegol warning

A

Risk of GI perforation

115
Q

Methylnaltrexone & Naloxegol SE

A

Abdominal pain, flatulence

116
Q

Lubiprostone brand name

A

Amitiza

117
Q

Tramadol and tapentadol MOA

A

mu-opioid receptor agonists - inhibit NE reuptake (tramadol also inhibits reuptake of serotonin)

118
Q

Tapentadol DEA drug class

A

C2

119
Q

Tramadol DEA drug class

A

C-IV

120
Q

Tramadol warnings

A

Seizure risk, risk of serotonin syndrome when used alone or with other serotonergic drugs or inhibitors of 2D6 or 3A4

121
Q

Tramadol CI

A

Do not use in children < 12 years of age or in children < 18 years of age following tonsillectomy or adenoidectomy surgery
Do not use with MAOi or within 14 days

122
Q

Tramadol & Tapentadol side effects

A

dizziness, constipation, nausea, somnolence

123
Q

Tramadol requires conversion to active metabolite by which CYP enzyme

A

2D6

124
Q

Tapentadol warnings

A

Can increase seizure risk

Risk of serotonin syndrome

125
Q

Suboxone is formulated with which abuse deterrent medication

A

Naloxone

126
Q

Which two opioids are manufactured using specific technology designed to deter crushing, dissolving or other modifications

A

OxyContin & Hysingla ER

127
Q

Buprenorphine MOA

A

partial mu-opioid agonist (agonist at low doses and antagonist at high doses)

128
Q

Given by itself, naloxone is used for

A

opioid overdose

129
Q

Buprenorphine/naloxone combination products are used as alternatives to

A

methadone (buprenorphine suppresses withdrawal symptoms and naloxone helps prevent misuse)

130
Q

Which 3 formulations does naloxone come in

A

Evzio (auto-injector)
Narcan (nasal spray)
Naloxone (injection)

131
Q

Naloxone SE

A

acute withdrawal symptoms (pain)

132
Q

Buprenorphine drug schedule

A

C3

133
Q

Buprenorphine + naloxone brand name

A

Suboxone

134
Q

Buprenorphine patch (Butrans) should be changed how often

A

weekly

135
Q

How should Buprenorphine patch be disposed

A

fold sticky sides together and flush

136
Q

side effects from Buprenorphine patch

A

dizziness, HA, application site reactions, nausea

137
Q

To prescribe for opioid dependence, prescribers need a ____ waiver

A

Drug Addiction Treatment Act (DATA 2000)

138
Q

If a prescriber has authorization from the DEA to prescribe for opioid dependence, what will the DEA number start with

A

X

139
Q

Butrans patch can be covered with:

A

permitted adhesive film dressings: Bioclusive or Tegaderm

140
Q

Gabapentin brand name for post herpetic neuralgia and RLS

A

Horizant

141
Q

Gabapentin SE

A

Dizziness, somnolence, peripheral edema

142
Q

Pregabalin DEA drug class

A

C-V

143
Q

Pregabalin SE

A

Dizziness, somnolence, peripheral edema, weight gain, mild anxiolytic

144
Q

Pregabalin is approved for which conditions

A

fibromyalgia, post herpatic neuralgia, and neuropathic pain

145
Q

What is the only FDA-approved medication for trigeminal neurlgia

A

Carbamazepine (tegretol)

146
Q

Baclofen brand name

A

Liosesal

147
Q

SE for all muscle relaxants

A

excessive sedation, dizziness, confusion, asthenia (muscle weakness)

148
Q

Cyclobenzaprine brand names

A

Amrix, Fexmid, Flexeril

149
Q

Cyclobenzaprine side effect

A

dry mouth

Serotonergic

150
Q

Tizanidine SE

A

Hypotension, dry mouth

151
Q

Carisoprodol brand name

A

Soma

152
Q

Carisoprodol DEA class

A

C-IV

153
Q

Poor ____ metaboilizers will have increased Carisoprodol concentrations

A

2C19

154
Q

Which muscle relaxant is used for malignant hyperthermia

A

Dantrolene (Dantrium)

155
Q

How long can lidoderm patches be used per day

A

12 hours/day

156
Q

Which topical patch is approved for PHN (shingles) pain

A

Lidoderm

157
Q

Which topical patch can be cut into smaller pieces

A

Lidoderm

158
Q

Do not apply more than __ patched of Lidoderm at a time

A

3

159
Q

How often can Capsaicin be used

A

TID-QID

160
Q

Capsaicin brand names

A

Zotrix, Zostrix HP

161
Q

Capsaicin counseling

A

Do not touch genitals, nasal area, mouth or eyes after application & wash hands after applying

162
Q

Trolamine brand name

A

Aspercreme

A - NAPLEX (83 decks)

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